Gastroscopy with oesophageal dilatation

Before your appointment

• All medications should be taken as normal with a little water.
• If you are taking Warfarin or Clopidogrel or other blood thinning medication please contact the Endoscopy Nurses when you receive this information on 01223 216515. You may need to stop your medication prior to your procedure. If you take Aspirin only please continue.
• If you have diabetes please read the advice further down the page.
• If you have any questions about the procedure or find that you cannot keep this appointment please contact the Endoscopy Office between 09:00 and 17:00 Monday to Friday on 01223 257080.

On the day

• Do not have any food for six hours and nothing to drink for four hours before your appointment
• Please ensure you have arranged an escort to take you home. We cannot sedate you if you do not provide details of your escort.

At the hospital

• Please come to the endoscopy department on level 3 of the Addenbrookes Treatment Centre (ATC).
• Use the ‘Car Park 2’. The car park is busy early in the morning; please allow yourself enough time to arrive in time for your appointment. Take your parking ticket to the Endoscopy reception desk to have your ticket stamped; this will enable you to have discounted parking.
• Please note you need to arrive 30 minutes prior to your appointment time for your pre procedure check. The length of time you will be here will vary enormously but may be anything from two to four hours or more. Please ask your admitting nurse for further information during your admission check.

What is an oesophageal dilatation?

You are experiencing difficulty swallowing due to a narrowing (stricture) your oesophagus (gullet). The commonest reasons for this treatment are Achalasia (a condition where the lower gullet muscle becomes very tight), scarring strictures associated with stomach acid damage (heartburn) or following oesophageal surgery. Your doctor thinks that it is possible and appropriate to try to improve your symptoms by stretching the narrow part using endoscopy rather than a surgical operation.

Firstly, we use a gastroscope to inspect your oesophagus then a stretching device, which is an inflatable pressure balloon, is passed through the gastroscope and positioned across the narrowed area. The balloon is inflated to certain pressures and as the balloon expands, the narrowed area expands to the same size. We use different sizes of balloon to reach the right size to improve your symptoms.

The procedure will usually take between 5 and 15 minutes but sometimes may take longer

Sometimes it is helpful to take a biopsy – a sample of the lining of the gut. A small instrument, called forceps, passes through the gastroscope to ‘pinch’ out a tiny bit of the lining (about the size of a pinhead). This sample is sent to the laboratory for analysis.

Getting ready for the procedure

Wear loose fitting washable clothing and leave valuables at home.

On arrival to the department

Please register your arrival with the receptionist, they will ask for your pre-procedure questionnaire. Some patients may arrive after you but be seen quicker; we have seven procedure rooms all undertaking different procedures therefore patients are not seen in arrival order.

Before your procedure you will meet one of the nurses who will ask you some health questions, explain the procedure to you.

Once this is completed, you will be escorted to a single sex changing area. You are able to wear your own clothes for this procedure. Your escort cannot wait with you from this point and can leave the department until you are ready to go home.

You can change your mind about having the procedure at any time.

Sedatives

This procedure is undertaken with intravenous sedation. This will be administered via a plastic tube called a cannula which is inserted into a vein, and will make you feel relaxed and sleepy but not unconscious (this is not a general anaesthetic). In addition, we will also give you some pain relief. This means you may not be aware of the procedure.

 You will need to stay whilst you recover which may take up to an hour or more.

 You will need to be escorted home; your procedure will be cancelled if you do not have an escort.

 The injection will continue to have a mild sedative effect for up to 24 hours and may leave you unsteady on your feet for a while.

What happens during the procedure?

You will be collected from the changing room by the endoscopist and taken to a private bay to complete your consent form, when this has been completed they will escort you to the procedure room. The team in the procedure room will introduce themselves and ask you some questions; this is to confirm you are ready and prepared to continue with the procedure.

We will ask you to remove any glasses, dentures and hearing aid in the left ear and you will be made comfortable on a couch, lying on your left side. The endoscopist will give you the injection. We will put a plastic guard into your mouth so that you do not bite and damage our instrument. We will also put a plastic ‘peg’ on your finger to monitor your pulse and oxygen levels. For your comfort and reassurance, a trained nurse will stay with you throughout.

As the gastroscope goes through your mouth you may gag slightly, this is quite normal and will not interfere with your breathing. You may feel the balloon as it is put into place; most people find this not too uncomfortable.

During the procedure, we will put some air in to you so that that we have a clear view; this may make you burp and belch a little. This is also quite normal but some people find it unpleasant. We will remove the air at the end.

Minimal restraint may be appropriate during the procedure. However, if you make it clear that you are too uncomfortable the procedure will be stopped.

Potential risks

Oesophageal dilatations carry a very small risk (1 in 100 cases) of haemorrhage (bleeding) or perforation (tear) of the gut following which surgery may be necessary to repair it. There may be a slight risk to crowned teeth or dental bridgework, and you should tell the endoscopist if you have either of these. Other rare complications include aspiration pneumonia (inflammation of the lungs caused by inhaling or choking on vomit) and an adverse reaction to the intravenous sedative drugs.

After the procedure

We will take you to a recovery area while the sedation wears off. When you are sufficiently awake, we will give you a drink before you get dressed. You can then go home; this may be up to an hour following the procedure.

It is quite likely that your throat and oesophagus will feel slightly sore particularly where it was dilated. Please tell the staff if it becomes too uncomfortable.

Some people who have this procedure need to be admitted to hospital. If however you go home on the same day you are advised not to drive, operate machinery, return to work, drink alcohol or sign legally binding documents for a 24-hour period after the procedure. We also advise you to have a responsible adult to stay with you for the next 12 hours. You can eat and drink as normal.

You may feel a little bloated and have some wind-like pains because of the air in your gut; these usually settle down quickly.

We will always do our best to respect your privacy and dignity, e.g. with the use of curtains. If you have any concerns, please speak to the department sister or charge nurse.

When will I know the result?

The endoscopist or endoscopy nurse will tell you about the procedure in the recovery area when you are awake. If you would like more privacy, we will take you to a private room.

The sedation can affect your ability to remember any discussion. If you would like someone with you when you talk to the endoscopist or endoscopy nurse please inform the nurse looking after you who will arrange for you to be seen in a private room with your escort when they arrive.

The final results from biopsies will be given to you either by the healthcare professional who requested the procedure at a clinic appointment or by letter. These results can take several weeks to come through. You should discuss details of these results and any further treatment with that person.

After discharge

We will provide you with an information sheet on discharge which will detail who to contact if you require any assistance after the procedure.

Alternatives:

As a therapeutic intervention, there are no real alternatives to oesophageal dilatation; concerns regarding possible alternatives should be discussed with the doctor who recommended this treatment.

For more information

Contact the endoscopy office between 09:00 and 17:00 on 01223 216546.

Advice for patients with diabetes undergoing endoscopic procedures

Introduction

This information has been provided for patients with diabetes to help you understand how to manage your diabetes in preparation for your procedure:

• Gastroscopy
• Enteroscopy
• ERCP
• EUS

If you require further information or are unsure what guidance to follow please contact the endoscopy nurses on 01223 216515.

Patients having a gastroscopy, enteroscopy, ERCP or EUS

Ensure you follow the nil by mouth requirements in the procedure leaflet provided.

If you control your diabetes with diet alone:

No changes required.

Eat and drink after the procedure as normal

If you control your diabetes with tablets or non-insulin injectables:

Examples of non-insulin injectables include semaglutide (Ozempic), liraglutide (Victoza), dulaglutide (Trulicity), exenatide (Bydureon), lixisenatide (Lyxumia), Tirzepatide (Mounjaro)

On the day of the procedure only:

• If you have a morning appointment – omit all oral medication and non-insulin injectables on the day of your procedure
• If you have an afternoon appointment – take your usual morning dose only (oral medication or non-insulin injectable). If you normally take your medication at lunchtime or the evening do not move the missed doses to the morning before your appointment.

Resume all usual medications once eating and drinking normally

If you control your diabetes with insulin:

On the day of your procedure

• Test your blood sugar every 2 hours after waking
• Bring your glucose (+/- ketone) meter and medications (including insulin) with you
• Carry hypoglycaemia (low blood glucose) treatment with you. If you have a hypoglycaemic episode in the 3 hours before the procedure take 60mls of oral treatment or 4 glucotablets
• You can resume usual treatment when eating and drinking normally.

Please follow the guides below for your insulin regime:

If your diabetes medication or insulin is not listed above contact your usual Diabetes Specialist Nurse for advice.

Insulin adjustment guide: